Benign multicystic peritoneal mesothelioma in a postmenopausal woman complicated with an ovarian cyst: a case report.

Benign multicystic peritoneal mesothelioma is a rare cystic neoplasm, characterized by subtle symptoms, that occurs predominantly in reproductive-aged women. The pathogenesis and etiology of the disease are yet to be determined. We herein present a 71-year-old woman presented to our clinic with persistent low back pain. The clinical examination showed a palpable mass in the abdominal area. The magnetic resonance imaging revealed multiple cystic lesions that occupy the largest part of the pelvis, posterior to the uterus. The patient underwent cyst excision, total hysterectomy with bilateral salpingo-oophorectomy, omentectomy and lymph node dissection. Postoperative course was uneventful and histopathology of the specimen revealed a benign multicystic peritoneal mesothelioma. Complete tumor resection is considered the optimal therapeutic approach of peritoneal mesothelioma. Histopathological analysis is required to confirm the diagnosis of multicystic peritoneal mesothelioma.

Shift Work and Quality of Personal, Professional, and Family Life among Health Care Workers in a Rehabilitation Center in Greece.

CONTEXT: Adverse work schedules and conditions may affect the physical, mental, and social wellbeing of workers, impairing quality of life and causing conflict between family and work roles. AIMS: To compare quality of life, professional quality of life (ProQOL), and work/family conflict (WFC) between shift workers and nonshift workers and explore possible associations with demographic characteristics. SETTINGS AND DESIGN: : A cross-sectional study was conducted in a rehabilitation center in Central Greece, recording demographic, occupational, and family characteristics. MATERIALS AND METHODS: Participants answered the World Health Organization-5 Well-Being Index, the ProQOL questionnaire [compassion satisfaction (CS), and the burnout (BO) and secondary traumatic stress scales], and the WFC scale. STATISTICAL ANALYSIS USED: IBM Statistical Package for the Social Sciences version 19.0 for Windows. RESULTS: Ninety-one employees (68.7% shift workers) participated, with mean age 33.5. Females reported higher compassion/satisfaction level (P = 0.031). Nursing profession was associated with higher levels of BO (P = 0.021), impact of work to family life (P = 0.008), and impact of family to work (FtW), and WFC (P = 0.008). Parenthood increased the impact of FtW (P = 0.008) and predispose to WFC (P = 0.023). In general, wellbeing was significantly correlated with CS (r = 0.368, P < 0.01), BO (r = -0.538, P < 0.01), and levels of WFC (P = 0.003). Work and family roles conflict was statistically significantly correlated with levels of BO (r = 0.497, P < 0.01), and CS (r = -0.288, P < 0.01). CONCLUSIONS: The interaction between general, professional, and family quality of life can guide interventions in the workplace in order to improve workers' quality of life and promote workers' health.

The role of cytokines and hot flashes in perimenopausal depression.

BACKGROUND: An imbalance in the production of proinflammatory and anti-inflammatory cytokines may play a role in the pathophysiology of perimenopausal depression. The aim of this study was to examine serum levels of the proinflammatory cytokines interleukin 6 (IL-6) and tumor necrosis factor α (TNFα), and the anti-inflammatory cytokine IL-10, in perimenopausal women suffering from depression. Furthermore, to assess whether serum cytokine levels are associated with the presence of hot flashes or the use of selective serotonin reuptake inhibitors (SSRIs). We also evaluated the possible association of hot flashes and perimenopausal depression. METHODS: Serum samples from 65 perimenopausal women, 41 with depression and 24 without depression, were assessed for serum IL-6, TNFα and IL-10 by conventional enzyme-linked immunosorbent assays. Depression was evaluated by the 17-item Hamilton Depression Rating Scale (HAM-D 17) and a psychiatric interview. The presence and severity of hot flashes were examined using the Menopause Rating Scale (MRS). RESULTS: Serum levels cytokines did not differ between depressed women and normal controls. Serum levels of cytokines did not change significantly in depressed women with hot flashes or in depressed women treated with SSRIs. Hot flashes were strongly associated (P < 0.0001) with perimenopausal depression. CONCLUSION: The study supports the hypothesis that perimenopausal depression is not characterized by increased proinflammatory cytokines and decreased anti-inflammatory cytokines. Women with perimenopausal depression suffer from more severe and more frequent hot flashes than women without perimenopausal depression.

Soluble FMS-like tyrosine kinase-1 (sFlt-1) and serum placental growth factor (PlGF) as biomarkers for ectopic pregnancy and missed abortion.

CONTEXT: Diagnosis of early pregnancy failure is hampered by the lack of reliable serological markers. OBJECTIVE: We assessed whether a single serum measurement of placental growth factor (PlGF) and the soluble Flt-1 (sFlt-1) receptor of vascular endothelial growth factor at 6-8 wk gestation could differentiate failed pregnancies, whether ectopic pregnancies (EP) or missed abortions (MA), from healthy intrauterine pregnancies (IUP). DESIGN AND SETTING: We conducted a prospective clinical study at a tertiary university hospital between January 2009 and February 2011. PATIENTS: A total of 78 consecutive patients (38 EP, 40 MA) with failed early pregnancy and 50 IUP (control group) participated in the study. INTERVENTION(S): Determination of serum PlGF and sFlt-1 has been carried out by ELISA. Gene expression of PlGF and Flt-1 in trophoblasts was performed by RT-PCR. MAIN OUTCOME MEASURE(S): We investigated whether a single, combined serum measurement of the above markers could contribute to the differential diagnosis. RESULTS: PlGF and sFlt-1 concentration was lower in both EP (mean, 14.60 ± 3.42/178.16 ± 76.03 pg/ml) and MA (mean, 16.25 ± 4.73/399.42 ± 337.54 pg/ml) compared to IUP (mean, 21.64 ± 5.68/1390.32 ± 655.37 pg/ml). sFlt-1 (P = 0.033) and sFlt-1/PlGF ratio (P = 0.029) but not PlGF had the ability to discriminate MA from EP. Compared to women with viable IUP, mRNA gene expression levels of PlGF and Flt-1 were considerably lower in women with MA and in women with EP. CONCLUSIONS: Combined measurement of sFlt-1 and PlGF levels can differentiate normal from failed pregnancies, whereas sFlt-1 as well as sFlt-1/PlGF ratio can also discriminate EP from MA. PlGF and Flt-1 gene expression in trophoblasts from women with EP and MA appears impaired.

Expression of 6 common antigenic markers in invasive ductal breast carcinoma: potential clinical implications.

Expression of estrogen (ER) and progesterone receptors, c-erbB-2 oncogene, mutant p53 antioncogene (mp53), e-cadherin adhesion, and apoptotic caspase-8 antigens in tumor relative to matched normal tissue specimens from 102 unselected patients with primary ductal breast carcinoma of various tumor grades was assessed by immunohistochemistry and correlated with patient's biologic and clinical features, such as age, menstrual status, age of menarche, tumor grade and diameter, the presence or absence of metastases, and number of infiltrated lymph nodes. We observed association of e-cadherin adhesion, ER and progesterone antigen marker expression with low histologic grade tumors and limited number of lymph node metastases and of c-erbB-2, mp53, and casp-8 antigen marker expression with high histologic grade tumors and increased number of lymph node metastases. We also observed strong correlation (P<0.05) between 4 of the 6 biomarkers and 4 of the 7 patient/tumor parameters examined. Our findings support the hypothesis of independent expression of these 4 strong biomarkers and reveal that nearly 40% of all breast tumor cases studied express similar proportions of 2 major phenotypic combinations [ER/c-erbB-2/mp53/casp-8: +/+/-/+ (19.6%) & +/-/-/+ (17.8%)]. We conclude that, in agreement with earlier reports, our findings support the diagnostic and potential prognostic value of these markers in the clinical assessment of breast cancer.

Ruptured heterotopic interstitial pregnancy: rare case of acute abdomen in a Jehovah's Witness patient.

OBJECTIVE: To report a case of ruptured right heterotopic interstitial pregnancy diagnosed and managed laparoscopically by cornual resection. DESIGN: Case report. SETTING: University tertiary care hospital. PATIENT(S): A 29-year-old female Jehovah's Witness patient with first-trimester acute right lower quadrant abdominal pain. INTERVENTION(S): Emergency laparoscopy was performed, and the site of bleeding was first clamped with a laparoscopic grasper. The lateral tissue was then coagulated and simultaneously transected with the bipolar-cutting probe for control of hemorrhage. MAIN OUTCOME MEASURE(S): The early diagnosis of heterotopic interstitial pregnancy should enable a conservative approach, whether medical or surgical, to be undertaken when treating this rare and potentially fatal condition. RESULT(S): The treatment of a ruptured heterotopic interstitial pregnancy by laparoscopy was successful with cornual resection. CONCLUSION(S): Management of a ruptured interstitial pregnancy by laparoscopy was successful with cornual resection and minimal blood loss, and a coexiting intrauterine pregnancy continued satisfactorily.

Uterine perforation as a rare complication of attempted pregnancy termination with misoprostol: a case report.

BACKGROUND: Abortion induced by drugs is now a viable alternative to surgically induced abortion, but it can cause severe complications. CASE: Products of conception were found in the peritoneal cavity after administration of misoprostol. CONCLUSION: The administration of misoprostol for pregnancy termination should be performed carefully in women with uterine wall defects.

Novel serum inflammatory markers in patients with adnexal mass who had surgery for ovarian torsion.

OBJECTIVE: To determine the diagnostic value of preoperative levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), interleukin-8 (IL-8), and E-selectin in patients with an adnexal mass who had surgery for ovarian torsion. DESIGN: Prospective study. SETTING: University hospital. PATIENT(S): Fifty consecutive women with adnexal mass who were admitted with a diagnosis of ovarian torsion. INTERVENTION(S): All had a single preoperative measurement of IL-6, IL-8, TNF-alpha, and E-selectin by ELISA. MAIN OUTCOME MEASURE(S): To determine if a single preoperative serum sampling of IL-6, IL-8, TNF-alpha, and E-selectin by ELISA can diagnose ovarian torsion. RESULT(S): Thirteen patients had proven torsion of the ovary. Serum levels of IL-6 were significantly higher in the 13 patients with proven ovarian torsion compared with the 37 without ovarian torsion. Patients with IL-6 serum values > or =10.2 pg/mL had a 16 times higher risk of having ovarian torsion. No significant difference was found in TNF-alpha, IL-8, and E-selectin between the two groups. CONCLUSION(S): The IL-6 levels might assist in the prompt diagnosis of ovarian torsion and allow a timely surgical intervention.

Recombinant human erythropoietin in a triplet pregnancy: a case report.

BACKGROUND: Women carrying triplets are at greater risk for both anemia, due to the increased demands of the developingfetuses, and peripartum hemorrhage. Jehovah's witnesses are a unique obstetric population since women of this faith refuse blood transfusion. CASE: A Jehovah's Witness with a triplet pregnancy was successfully administered recombinant human erythropoietin (rHuEpo), 200 IU/kg 3 times per week subcutaneously, in order to correct her peripartum anemia. No side effects were observed during rHuEpo therapy, and the patient delivered healthy triplets. CONCLUSION: rHuEpo can be safely administered, with a beneficial effect in pregnancy, and seems to be an effective option in preventing transfusions as demonstrated in this case in a Jehovah's Witness.